Impact of myocardial scar burden on microvascular resistance reserve in patients with coronary artery disease

IF 7.6 1区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING European Journal of Nuclear Medicine and Molecular Imaging Pub Date : 2025-02-20 DOI:10.1007/s00259-025-07112-6

Masahiro Hoshino, Roel Hoek, Ruurt. A. Jukema, Jorge Dahdal, Pepijn van Diemen, Luuk H. G. A. Hopman, Pieter Raijmakers, Roel Driessen, Jos Twisk, Ibrahim Danad, Tsunekazu Kakuta, Juhani Knuuti, Paul Knaapen

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Abstract

Purpose

The impact of myocardial scar on coronary microcirculation is not well understood. This study aims to evaluate the association between microvascular resistance reserve (MRR) and scar tissue.

Methods

In this post-hoc analysis of the PACIFIC 2 trial, symptomatic patients with prior myocardial infarction (MI) and/or percutaneous coronary intervention (PCI) underwent [¹⁵O]H₂O positron emission tomography (PET), cardiac magnetic resonance (CMR) imaging, and fractional flow reserve (FFR). MRR was assessed utilizing PET-derived coronary flow reserve and FFR measurements. Scar quantification was assessed by CMR late gadolinium enhancement (LGE). Vessel LGE burden was defined as the scar tissue proportion in each myocardial territory. Total LGE burden was defined as the proportion of overall scar.

Results

The study included 154 patients with 397 vessels with a mean MRR of 3.56 ± 1.24. Patients with any scar tissues (LGE > 0%) exhibited a lower MRR in every myocardial territory than those without scar tissues. After adjusting for cardiovascular risk factors, either vessel LGE burden (β =-0.013, P = 0.006) or total LGE burden (β =-0.039, P = 0.002) independently predicted a reduced MRR. Compared to myocardial territories without scar tissues (LGE burdens = 0%), MRR was significantly lower in myocardial territories with vessel LGE burden = 0% + total LGE burden > 0%, and in myocardial territories with both LGE burdens > 0%.

Conclusion

Scar burden was negatively associated with MRR in patients with prior MI and/or PCI. Our findings indicate that both the proportion of myocardial scar in the vascular territory and the overall myocardial scar affect the microcirculation of individual vascular territories.

Clinical trial number

Not applicable.

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心肌瘢痕负荷对冠心病患者微血管阻力储备的影响

目的心肌瘢痕对冠状动脉微循环的影响尚不清楚。本研究旨在评估微血管阻力储备（MRR）与疤痕组织的关系。方法在对pacific2试验的事后分析中，有症状的既往心肌梗死（MI）和/或经皮冠状动脉介入治疗（PCI）的患者接受了[15O]H2O正电子发射断层扫描（PET）、心脏磁共振（CMR）成像和分数血流储备（FFR）。利用pet衍生的冠状动脉血流储备和FFR测量来评估MRR。通过CMR晚期钆增强（LGE）评估疤痕量化。血管LGE负荷定义为疤痕组织在各心肌区域的比例。LGE总负担定义为疤痕占总疤痕的比例。结果154例患者397支血管，MRR平均值为3.56±1.24。有任何疤痕组织的患者（LGE为0%）在各心肌区域的MRR均低于无疤痕组织的患者。在调整心血管危险因素后，血管LGE负荷（β =-0.013, P = 0.006）或总LGE负荷（β =-0.039, P = 0.002）独立预测MRR降低。与无瘢痕组织心肌区域（LGE负荷= 0%）相比，血管LGE负荷= 0% +总LGE负荷>； 0%的心肌区域，以及同时有LGE负荷>； 0%的心肌区域，MRR显著降低。结论既往心肌梗死和/或PCI患者的疤痕负担与MRR呈负相关。我们的研究结果表明，心肌疤痕在血管区域的比例和整体心肌疤痕都会影响单个血管区域的微循环。临床试验编号不适用。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

European Journal of Nuclear Medicine and Molecular Imaging 医学-核医学

CiteScore

15.60

自引率

9.90%

发文量

392

审稿时长

3 months

期刊介绍： The European Journal of Nuclear Medicine and Molecular Imaging serves as a platform for the exchange of clinical and scientific information within nuclear medicine and related professions. It welcomes international submissions from professionals involved in the functional, metabolic, and molecular investigation of diseases. The journal's coverage spans physics, dosimetry, radiation biology, radiochemistry, and pharmacy, providing high-quality peer review by experts in the field. Known for highly cited and downloaded articles, it ensures global visibility for research work and is part of the EJNMMI journal family.